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WINTER PARK PHARMACY
STD327924 Doctor's Goodwill Foundation Inc
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Covered Entity Details
Entity Name
Doctor's Goodwill Foundation Inc
Subdivision Name
JS Healthcare
Type
Sexually Transmitted Diseases
340B ID
STD327924
Entity Address
201 N Lakemont Ave
Winter Park, FL 32792
Grant Number
H25PS005131
Participating Start Date
9/29/2020
Last Recertification Date
5/3/2021
Entity Termination Date
10/1/2021
Pharmacy Details
Pharmacy Name
WINTER PARK PHARMACY
Pharmacy Address
HEAL N HALE LLC
3090 ALOMA AVE STE 140
WINTER PARK, FL 32792-3743
Pharmacy Comments
Contract Details
Approval Date
9/29/2020
Contract Begin Date
9/29/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kantilal Bhalani, CEO
(321) 298-5531 Ext: 9414416212
Contract Pharmacy Representative
Winter Park Pharmacy
Shruti Patel, Manager
(407) 636-4670
Signed By Date
9/29/2020
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